When you buy insurance, you don’t anticipate for the worst to happen, you buy it for comfort and peace of mind. Health insurance is designed to allow individuals who are insured to pay premiums that will assist them in paying their medical bills and covering their medical treatment. And with the cost of healthcare continuing to skyrocket, many Americans more than ever trust that their insurance company will make good on its promise to cover and pay for necessary healthcare treatment and procedures. However, far too often, insurers become adversaries rather than support systems by denying or delaying coverage and payment for medical claims.
Just as the insured has a responsibility of paying their premiums, the insurer is also legally responsible for acting in good faith and taking several actions. For instance, the insurance company must explain the reasons for coverage or claim delay or denial, including providing information about how to appeal the denial. But insurance companies are in this business to make profits and often use a variety of tactics to deny health insurance unjustly. It’s unfortunate that many people do not have means or the understanding to fight these large insurance carriers.
Stop Health Insurance Denial helps policyholders and families across the United States force insurance companies to keep their promise and terms of health insurance policies. Our attorneys assist clients with all elements of health insurance disputes, including understanding the claims process, filing a lawsuit against an insurer, and appealing a denied claim.
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Facing a serious medical diagnosis or the probability of one can create a lot of uncertainty and a stressful situation. And just when you think you’re covered as far as paying for the medical costs is concerned, you get a rude shock when your insurance company denies a test, medication, or treatment that is medically necessary for you.
Anthem is one of the nation’s biggest health insurance companies but also one that has endeavored to delay payments, deny claims, refuse anyone who may cost them money, and confuse consumers with unfathomable insurance-speak. Anthem, like any other insurance company, is in business to make money and know that their bottom line may be negatively affected if they continually pay on every claim they receive. For the millions of Anthem subscribers who faithfully pay their premiums, being denied coverage when they need it most can be quite infuriating and worrisome.
Some of the common reasons that Anthem give for denying coverage include:
Regardless of the reason, you do not have to accept a claim denial. An experienced Anthem insurance attorney can help determined if the denial was fair and if it wasn’t, they can face Anthem and fight the claims denial on your behalf
Every day in the U.S, millions of people rely on their health insurance to cater for their medical treatment and procedures. This can be something from hospital visits and check-ups to lab work and surgeries. Health insurance holders expect their policies to cover the expenses. Unfortunately, it’s common for coverage or service for sick and injured people to be denied. Insurance companies look after their bottom line and that’s why they’re always eager to accept premiums and then avoid paying for claims. They can come up with all sorts of reasons to avoid payments that may be valid under the law, including stating that the provider is out-of-network, the medical care was not necessary, or the treatment is experimental or a clinical trial.
Denial of a health insurance claim can threaten a person’s ability to access health care as well as their overall financial security. So, when your health insurance carrier just won’t honor their promise, it doesn’t have to be the end of the story. If your request for pre-authorization of medical treatment or procedure has been denied or your health insurance claim has been denied or terminated by your health insurance plan, you’re likely facing the prospect of some kind of claim review process or appeal. And since the rate of appeals rejection by insurance carriers is also high, you may need the help of an experienced health insurance denial appeals lawyer to help you with the process. You have the legal burden of proving that you’re entitled to benefits. This means that your appeal must contain a critique of your claim denial and enough occupational and medical evidence to show the medical necessity of your treatment, medication, hospitalization, and surgical procedure. We help you prepare a timely and effective appeal for your denied health insurance claim.
An insurance policy is a contract between the carrier and the insured. The parties have rights and duties as mentioned in a mutually agreed contract, also referred to as a health plan agreement, insurance contract, or Evidence of Coverage. When one of the parties fail to act according to what’s agreed to within the contract, that is what is known as a breach of contract. For a health insurance carrier, it could be changing or not honoring the terms as agreed on. For instance, an insurance company could potentially be held liable in a court of law if it were to deny a claim that is covered under the contract. For the insured, breaching the contract could mean not paying their insurance premiums or their copays/deductibles.
Every health insurance contract contains an invisible, unwritten, and implies term known as promise of good faith and fair dealing. Insurance companies are expected to always act fairly in handling their claims. Health insurance carriers often bank on the fact that the contracts are incredibly complex and know that many applicants and policyholders will not take the time to read or even understand the terms. This leaves them at a disadvantage when their claim is denied and they have to appeal. The language used may convince the customer that everything’s covered and then convince the court that the claim is not.
At Stop Health Insurance Denial, we understand how stressful, and frustrating it can be when an insurer does not uphold their end of the agreement. A health insurance breach of contract lawyer can help you make an appeal or file a lawsuit against the carrier to get them to honor their contract.
Having your health insurance claim denied is often more than just a convenience. It could mean being left with a huge medical bill that you’ll have to pay out-of-pocket if you already underwent treatment or being forced to pay for a necessary and expensive treatment. Also, it may mean being left in a position where you’re not able to seek that much-needed medical care, which could result in the condition or disease progressing.
Every insurance company has a duty to act fairly and in good faith with respect to its policyholders, meaning that it cannot unreasonably deprive the insured of the benefits or unfairly frustrate them. If the insurance carrier unreasonably denies health insurance coverage or refuses to pay a valid benefit covered by the policy, the carrier may have acted in bad faith. If you were denied health insurance coverage, you may be allowed to collect extra-contractual damages arising from bad faith such as attorney’s fees, emotional distress, additional medical bills, and compensation for any other loss caused by the insurer’s unreasonable conduct. This is often paid in addition to compensation for your direct injuries. The dedicated lawyers at Stop Health Insurance Denial could explain your rights under your state’s insurance laws and help you pursue damages for health insurance claims denials.
Disability insurance provides protection to individuals who are unable to work because they’re temporarily or permanently disabled. These policies are often laced with “residual” versus “total” disability language. If a claim has not been denied by a disability insurance carrier, chances are that a policyholder will be labeled as residually disabled in an effort to reduce the payout. Some other disability carriers will also attempt to reduce the duration of benefits. Some disability policies also cover the business overhead expense, which helps to keep a business afloat while the owner recovers.
You will likely go through an arduous task getting the insurance carrier to approve your claim as this includes presenting the attending physician statement forms, recorded statements, surveillance, independent medical examinations, field interviews, and navigate claimant statement forms. You must be careful when submitting these documents and during the claim investigation process because most of the requests made by insurance carriers are aimed at creating opportunities for claim denial. Having been down the claim investigation road countless times, Stop Health Insurance Denial lawyers can help you maximize the likelihood of claim approval so you obtain the benefits that you deserve.
If you are a business owner, executive, legal professional, or a high-income earner with disability insurance you most likely have a disability policy and should be able to rely on getting your claim paid. Disability insurance carriers make many promises about when and how a person will qualify for benefits, but since the benefits for high wage earners are high, the company will look into each claim more closely just to find an issue that will qualify a denial. For instance, they may say that the claimant is not fully disabled, that he or she failed to cooperate with the investigation, or a change of occupation resulted in the policyholder being not disabled. Whatever the case, you need the help of an Individual Disability attorney like those at Stop Health Insurance Denial to fight for the benefits you deserve.
When you purchase a health insurance policy, you put your trust in the insurance company you have opted for and also the insurance agent you will be working with. Insurance brokers and agents have responsibilities to the insured and must use reasonable care, judgment, and diligence in procuring the insurance requested by the customer. They are therefore liable if they perform their duties with utmost negligence. The negligence of an insurance broker or agent can occur at the point of purchase or further on in your relationship with the agent/company. Health insurance brokers and agents can act negligently and make errors that lead to malpractice.
Common errors and acts of negligence include:
Also, there are agents and brokers who hold themselves out as specialists or experts in a given area and this means that the duty of care they owe you is even higher. An insurance broker or agent may be eligible for their actions and the resultant damages. As an insured, you may be eligible for the amount equal to what you could have received in benefits and also compensation for all the detrimental damages caused thereby.
Many people tend to back away and drop valid insurance claims after becoming stressed and frustrated with the claims handling process. Many more give up after realizing that they don’t have the know-how or enough time to successfully dispute a denial. If the insurance company does not out rightly deny payment, it may simply delay it. Delayed payment can pose great financial hardship upon insureds, especially when one has an urgent need for the promised benefits.
Delayed benefits payment is all too common and insurance carriers use a variety of tactics to ensure the delay goes on as long as possible. They may insist that you see a doctor of their choosing, ask for many unnecessary supporting evidence, or accuse you of fraud. Delaying payment is primarily done to ensure that you’re frustrated so you give up on your claim. But every day that your payment is delayed by the insurance company is another day that your money sits in their bank account earning huge interests. The insurance policy gives you the right to prompt payment of claims. You may be a victim of insurance bad faith if your insurance carrier has unjustly delayed payment of a valid claim for benefits. The Stop Health Insurance Denial lawyers know all about health insurance law and the tricks that insurance companies employ to delay valid payments. If your insurance carrier acted in bad faith, we can pursue payment of your claim and also seek, punitive damages, where appropriate.
Anyone can apply for insurance coverage but when it comes to health insurance, there are requirements for eligibility under the health insurance plans that a health insurance carrier is obliged to follow. Common examples of health plans and health insurance policies include Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs). People who buy health insurance don’t sit there waiting for diseases to plague them, they buy the policy for trust and peace of mind.
Health insurance carriers cannot refuse to provide insurance under the Patient Protection and Affordable Care Act for certain individuals based on pre-existing disabilities or pre-existing conditions. In some states, insurers are obliged to provide coverage for certain medical treatments. But in addition to the federal and state eligibility requirements, insurance companies have the freedom to determine coverage within their plans.
Liability insurance is a broad category of insurance that deals with legal claims brought up against policyholders. For instance, if someone gets injured and sues you, you’ll use your liability insurance will to defend the lawsuit and compensate the victim. Automobile insurance includes liability provisions when you are involved in an accident that injures another person or damages their property. Your business or homeowner liability coverage protects you if a person is hurt on your property and has filed a claim. Typically, liability insurance policies cover negligent behavior and not intentional or willful acts by the policyholder.
Businesses are most vulnerable to lawsuits because they are open to the public and invite customers onto their premises. There is a possibility of shoppers and customers being hurt at your business or outside your business due to negligence or maybe something you were not aware of. Generally, liability insurance covers damage to other people’s property, bodily or personal injury to others, medical costs resulting from the accident, and the cost of your defense in the event that you’re sued.
Your insurance company owes you duties; a duty to defend and a duty to pay damages. This means that all the fees associated with the defense must be paid for by your insurer even if the lawsuit is not covered by the policy. Also, the insurance carrier must pay for all damages on your behalf. Liability insurance is often a complex area if the law with clauses and language that’s difficult to understand. What’s worse, your insurer may simply refuse to pay your claim by claiming that the accident was caused by your willful act or the event is outside your policy coverage. What they hope to do is frustrate you with a long fight that will intimidate you to give up, but Stop Health Insurance Denial can help when such situations arise.
Experiencing the death of a loved one can be an incredibly difficult moment in a person’s life. Fortunately, many people take out life insurance policies to provide the much-needed financial assistance- from funeral costs, burial expenses, to tax bills- for those left behind. However, many families often have to go through the complicated claims process before they can receive death benefits. While it should be a foregone conclusion that the insurance company will make the payout of a life insurance policy after a person’s death without any hurdles, these companies are interested in making profits and that only happens when they collect premiums, not when they pay out benefits. Unfortunately, life insurance delays and denials are all too common and the appeals process is rarely simple. When a coverage is denied following submission, it can make matters exponentially worse by pushing surviving family members into financial hardship.
Life insurance providers are known for challenging beneficiaries and the policyholder’s cause of death. For instance, the claim may be denied if the death was related to a suicide or homicide committed by the decedent. Other excuses that insurance companies give when they fail to honor their promise to provide benefits include:
As your legal advocates, we know the tactics they employ to escape liability and we’ll handle the legal fight so you can take the time you need to get back on your feet. Our attorneys will stand up for your rights and help you obtain what your loved one paid for.
Individuals who have long-term disability and have become unable to work for an extended period of time may benefit from a long-term disability insurance (LTD). The filing process can be incredibly complicated and frustrating and the matter worsens if an insurance company has denied your claim. You already have enough to worry about with medical bills, medical treatment and procedures, and any other complication caused by your deteriorated health. When you have so much going on in your life, do not fight with an insurance carrier who is determined to frustrate you, deny your claim, or offer a payout that is far less than what you expect. An experienced long-term disability lawyer can help.
People who need long-term care are not sick in the traditional sense, but they are no longer able to perform daily living activities like bathing, dressing, transferring, eating, and toileting. Daycare facilities, in-home care providers, nursing homes, and family members often help senior citizens with these activities. Long-term care insurance (LTCI) is meant to pay for the cost of these services. But the cost of providing this type of cater can quickly deplete an individual’s savings if there is no LTCI. Sadly, many senior citizens and their families are left financially destitute when they have to pay the crushing’s costs out of their own pockets when their long-term care insurance claims are denied. While the concept of long-term care insurance is simple, it can be extremely difficult, time-consuming, and frustrating to get claims paid. In your time of need and when you do not have the time and strength to fight with your insurance company, the last thing you want to hear is that your claim has been denied.
Insurance companies will engage in tactics and won’t hesitate to interpret the policy in their favor. If your long-term care insurance claim is delayed or denied and you need legal representation, the attorneys at Stop Health Insurance Denials can help you or your elderly family member fight the legal battle so you get the maximum benefits from your policy.
Not every medical cost is predictable. There are times when an individual has a medical emergency while traveling. When one is in such an unfortunate situation, he or she may be forced to seek medical care with an out-of-network provider through their health insurance coverage. In most cases, seeking health services with an out-network health provider means paying more for the services and in worst cases, it could mean having the claim completely denied. It’s also not unusual for insurance companies to state that a certain provider was in-network and then, later on, inform the insured that they were not when the medical services have already been rendered. You might even have sought emergency care with the facility that was closest to your location only to be told that your claim is invalid because the hospital was out-of-network. Perhaps you voluntarily chose an out-of-network provider because you have a rare, specific condition and you can only get the best treatment from a few doctors.
Such denials only leave a patient with thousands of dollars of medical costs that they’re expected to pay. Whatever the reason for the denial is, there may be legal avenues to demand that an insurance company covers the cost associated with the medical treatment, provided it was necessary. A capable out-of-network coverage denial lawyer can help you choose the path forward that gives you the best chance of having your treatment and procedures paid for.
Social Security Disability Insurance (SSDI) is a program intended to pay monthly benefits to individuals who become disabled before they reach retirement age and are not able to engage in any gainful employment. Only those with total, severe, long-term disability are eligible for SSDI benefits. While the resources are available to help those traveling through this road to get compensated, most people are forced to deal with government agencies with huge case backlog or insurance carriers looking to protect their bottom line. What’s more, you only have a 60-day period to file an appeal. Don’t wait, contact a Stop Health Insurance Denial SSDI denial attorney who can explore every available option and fight the agencies and companies to pursue the compensation you need.
Having to go into the hospital for surgery is usually a stressful time in an individual’s life. There’s the potential for a long recovery period and complication and these procedures are quite costly. Most people have a health insurance policy that they expect to help pay for the associated costs. But when it comes to paying for surgical procedures, many insurance companies are always prepared to put up a fight. They may cite different reasons for denying a claim, from questions regarding the necessity of the surgery to cost issues. When an insurance company denies payment because it has decided that the treatment is experimental, cosmetic, and not medically necessary, doctors and hospitals may withhold treatment. This is dangerous because the health of an individual denied a medically necessary surgery may suffer a severe or even fatal level.
Whether an individual needs surgery but the insurance provider denies payment or underwent an emergency surgical operation, he or she has a right to appeal all denials of coverage. If you’re in such a situation, a surgery denial attorney could analyze your claim and help you with the appeals process.
Wildfires are the most widespread of all natural disasters and when they get hold of something, there’s nothing that an ordinary citizen can do to contain the situation. After the damages has been done, the affected individuals tend to turn to their insurance carriers for help rebuilding their lives. But many are the time when insurance companies turn their backs on the policyholders and deny fire damage and loss claims. As a for-profit entity, your insurance company will do everything it can to avoid payouts, but ad required by the law, there must be a justifiable reason for denying a claim. The Unfair Claim Settlement Practices Act (UCSPA), which has been adopted by many states aims to protect the insured from deceitful or wrongful actions of their insurance providers. Here are some of the most common forms of unfair claims handling:
The valuation or payment of a claim may be denied or delayed if the insurance carrier alleges that arson or fraud played a role in the fire that consumed your property or causes serious injuries. Definitely, your damages will not be covered if you played a role in causing the fire. But in such a case, it’s upon the insurance company to prove that you were involved. As such, an insurance company may be deemed to be acting in bad faith if there’s no direct or circumstantial evidence. Those who have suffered wildfire damage and loss may be eligible for compensation with the help of a credible attorney.
If your health insurance claim was denied by your insurance company or you’ve applied for benefits and have not received a response promptly, the skilled and experienced attorneys at Stop Health Insurance Denial can help you seek justice. Contact us today at 310-695-5241 or fill out our online contact form to discuss taking legal action with one of our attorneys